Healthcare Provider Details

I. General information

NPI: 1285438499
Provider Name (Legal Business Name): PEER OUTREACH RECOVERY & REENTRY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2025
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 N COUNTRY CLUB DR STE 34
MESA AZ
85201-5725
US

IV. Provider business mailing address

423 N COUNTRY CLUB DR STE 34
MESA AZ
85201-5725
US

V. Phone/Fax

Practice location:
  • Phone: 602-816-1493
  • Fax:
Mailing address:
  • Phone: 602-816-1493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MANUEL THOMAS ROBINSON
Title or Position: FOUNDER/CEO
Credential: CHW,PRSS
Phone: 602-816-1493